For those Medicare beneficiaries who are using Traditional Medicare and who are using Home Health Care for a longer term than just recooperating - Read and Heed:
In as a short of a nutshell as I can muster; a description of the problem: Beginning January 01, 2020, Medicare began a new reimbursement rate (reduced) for (some) Home Health Care services which covers maintanence services for long-term users of this type of care. Care for which enables the beneficiaries not to back-slide but which many times are taught to or performed with the daily caregiver on an intermittant time schedule.
According to this article from Kaiser Health News, some of the Home Health Care Agencies are responding aggressively, according to multiple interviews and are giving out false information. They are cutting physical, occupational and speech therapy for patients. They are firing therapists. And they are suggesting that Medicare no longer covers certain services and terminating services altogether for some longtime, severely ill patients.
Previously, Medicare’s home health rates reflected the amount of therapy delivered: More visits meant higher payments. Now, therapy isn’t explicitly factored into Medicare’s reimbursement system, known as the Patient-Driven Groupings Model (PDGM).
Instead, payments are based on a patient’s underlying diagnosis, the presence of other complicating medical conditions, the extent to which the patient is impaired, whether he or she is referred for services after a hospitalization or a stay in a rehabilitation center (payments are higher for people discharged from institutions) and the timing of services (payments are higher for the first 30 days and lower thereafter).
Agencies now have a stronger financial incentive to serve patients who need short-term therapy after a stay in the hospital or a rehabilitation facility. . . . . Also attractive will be patients who need nursing care for complex conditions such as post-surgical wounds.
At the same time, there are fewer incentives to serve patients who need extensive physical, occupational and speech therapy.
The new system encourages a “holistic” assessment of patients’ needs, and there’s convincing evidence that home health agencies sometimes provided too much therapy under Medicare’s previous system, . . . . . Between 2000 and 2016, Medicare home health therapy services soared 112%, according to the most recent data published by the Medicare Payment Advisory Commission.
But the risk now is that too little therapy will be offered. . . .
In an email, a spokesman for the Centers for Medicare & Medicaid Services said the federal agency is “monitoring the implementation of the PDGM, including therapy service provision, at the national, regional, state, and agency level.” (A similar system for skilled nursing facilities that provide rehabilitation was implemented in October.)
“We do not expect home health agencies to under-supply care or services; reduce the number of visits in response to payment; or inappropriately discharge a patient receiving Medicare homehealth services as these would be violations of [Medicare] conditions of participation. . . .
read more at the above link ~
Now there are some ways to combate this problem if you are involved in this and your Home Health Care Agency starts cutting services:
If you’re told Medicare’s home health benefits have changed, don’t believe it: Coverage rules haven’t been altered and people are still entitled to the same types of services . . . .
The ONLY thing that has changed is how Medicare pays agencies under a new system known as the Patient-Driven Groupings Model (PDGM). This system applies to home health services for older adults with original Medicare.
Under PDGM, agencies are paid higher rates for patients who need complex nursing care and less for people with long-term chronic conditions who need physical, occupational or speech therapy.
IF this is or has happened to you - read the rest of the above link for the steps that you should take.
NONE of this affects Managed-care-style Medicare Advantage plans which have their own rules.